Refractory amiodarone-induced thyrotoxicosis causing malignant arrhythmias, treated with therapeutic plasma exchange-bridged thyroidectomy.

Authors

Bisma Nazir, Myint Aye, Yasir Ihsan, Imran Mehdi Haidry, Inamullah Khan

Published in

BMJ case reports. Volume 19. Issue 10. Oct 05, 2026. Epub Oct 05, 2026.

Abstract

Amiodarone-induced thyrotoxicosis (AIT) is a potentially life-threatening complication of amiodarone therapy, particularly hazardous in patients with underlying structural heart disease. We report the case of a man in his mid-60s with severe cardiomyopathy and recurrent ventricular tachycardia who developed refractory thyrotoxicosis following amiodarone exposure. Overlapping features of type 1 and 2 AIT suggested mixed-type disease, posing a significant diagnostic challenge. Despite aggressive conventional therapy with high-dose thionamides and glucocorticoids, supplemented by adjunctive agents, including lithium and cholestyramine, thyrotoxicosis remained refractory and life-threatening arrhythmias persisted. Given the high cardiac risk and refractory disease course, total thyroidectomy was undertaken as definitive management; therapeutic plasma exchange was used as bridging therapy to achieve rapid biochemical improvement and minimise perioperative risk. This case highlights the complexity of managing severe, treatment-refractory AIT and underscores the value of multidisciplinary care and plasmapheresis as a bridging strategy prior to definitive surgical management.

PMID:
42833851
Bibliographic data and abstract were imported from PubMed on 06 Oct 2026.

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